LASIK Surgery Part II – The Epi-Lasik PRK Experience.

Fourteen years ago, after wearing glasses and hard contact lenses for over 15 years I took a chance on a new type of surgery called “Soft Brush” Epi-LASIK (PRK).  Flap LASIK surgery was first approved in the US in 1999 and when I had it performed in 2001 by Dr Kawesh at the Silicon Valley Laser Eye Center, it was a pretty new procedure and not without risks. But the idea of not wearing glasses and contacts was like an itch I couldn’t scratch and I decided the 10 thousand dollar price tag for both eyes was worth the benefit despite the risks and I pulled the trigger. I never looked back after the surgery, results were instantaneous, for me, and I enjoyed pain free, complication free vision from the first week on until my eye site began to degrade in my late 40s. Looking back, nearly ten years of perfect vision was worth the procedure. After ten years, I started using readers for the computer, and surgical loop magnifiers for dentistry.   I had researched that this was always a possibility and when my eye site began to get worse, it was no surprise.   By 2012,  I started wearing progressive prescription eyeglasses and sunglasses to sharpen up my long and short vision again.  Recently, another dentist told me about an adjustment procedure that could bring my vision back to 20/20 through a process called Wavefront Epi-LASIK (PRK). Although I would still need to wear readers,  I would be able to go back to not wearing glasses full time. Another procedure is currently available that corrects both long and near vision called refractive lens replacement which corrects both near and far sight refractive problems. Currently, there is a controversy on weather to use it to correct for reading glasses considering the success and lower risk of Epi-LASIK\PRK.   Some doctors feel that the risk of lens replacement is too great for only treating myopia and there are murky ethical and legal issues surrounding its use on non cataract patients. I remain optimistic that someday, lens replacement will be the treatment of choice over Lasik, for patients like myself who are aging and need readers, Having lasik now will not keep me off the list when the time comes and it is available. Cornea-Surface-Correction   The reason that Wavefront EPI-LASIK (PRK) is the indicated procedure to correct a previous flap LASIK procedure is the fact that no flap is cut. Excimer laser ablation is a very precise way of doing what old style PRK (incisional keratotomy) accomplished. The excimer laser corrects ametropia by sculpting or reshaping the outer de-epithelialized surface of the cornea to alter its refractive power. A clear contact lens is placed over the wound and the results after healing are significantly identical to flap LasiK. The major difference is healing time.

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It takes about 72 hours for the epithelium to heal over the laser wound. In the first couple days, I was prescribed Antibiotic and anti inflammatory drops for precaution and comfort. Topical anesthetic drops and anti-inflammatory eye drops for 1 or 2 days after PRK does not appear to delay re-epithelialization or cause keratopathy. Studies have also demonstrated that corticosteroids have no significant long-term effect on corneal haze or visual outcome after PRK. Other studies have demonstrated that steroids were effective in limiting haze and myopic regression after PRK, particularly after higher myopic corrections. Steroid drops are usually tapered over a 3- to 4-month period, depending on the patient’s corneal haze and refractive outcome. Keratocyte healing activity is maximal at 1 to 2 months. Abrupt termination of steroid drops at this time may trigger an excess healing reaction with haze formation and regression of the correction. Many studies have validated the safety and efficacy of myopic PRK. A 14-year follow up study of eyes ranging from -1.50D to -13.00 D showed stability of refraction, and no abnormalities in endothelial cell count or morphology, astigmatism, or ectasia. Alió et al. reported 10-year follow-up of eyes > -6.00 D with 58% of eyes within ± 1.00 D and 78% within ± 2.00 D. Mean haze was less at the 10-year time point compared to 3 months post-treatment. Epi-LASIK is a safe, effective, and predictable techniques for correcting low to moderate myopia, astigmatism, The primary disadvantages of advanced surface ablation are the degree of postoperative discomfort, length of time required for visual recovery, and increased corneal haze with treatment of higher refractive errors. For patients like me who have had previous surgery, surface ablation is preferable to LASIK Advances in wavefront-guide and wavefront-optimized ablations have made these modalities the mainstays of current treatment to date.

My Experiences Healing from PRK

DAY of Surgery.

I arrived for the surgery an hour before hand and topical anesthetic eye drops were administered to me half an hour before surgery. I brought a driver and was told that the procedure would take about an hour. Midpoint through my wait, the assistant came out and said that they had runout of gas, and that there would be a delay attaching an new canister of gas and calibrating the machine.  When I was fianlly escorted to the operator, I asked if I was the first patient to be seen after the new tank of gas and calibrations and she told me one eye preceded me and all went well. I turned down the Valium and pre dose of Motrin. I was not nervous and the procedure went as I had expected after my research. The laser was immense and I was impressed at how the technology had improved from 15 years ago. It again amazes me that the eye can get so numb with topical when it takes milliliters of liddocaine through a needle to get a single tooth numb. The procedure was absolutely painless but I could smell the laser burning off cells when it fired. The smell was the only indication that it was happening. They placed clear contact lenses over the surgical site and when I got up from the table, my vision was blurry and about half what it was when I laid down. I expected that. I thanked Dr Bindi and my daughter drove me home. I did not experience that scratchiness that some people describe. Aside from the blurry vision which even readers couldn’t help, I was feeling fine.

Day One

A lot was going on that day. The office was getting recarpetted and I had to rebuild a server and two workstations by brail if necessary. I had been putting the drops in as directed and my eye site was still terrible. I was seeing double through both eyes and could not read a message on my eye phone unless it was two inches from my left eye. I was a bit freaked out, since I remember my flap lasik surgery having virtually no recovery period. I knew this would take awhile but somehow I though I might be different and I would notice an improvement. I had no strain or pain–No headaches or light sensitivity. But the cooling pads were comfortable and it felt good to close my eyes and listen to music for a couple hours. I forgot when I had time to actually sit down and listen to music.

Day Two

Yikes, my vision is even more blurry. It seems that there is some improvement when I hydrate the heck out of my eyeballs. I hope its those clear contact lenses that are causing most of this. I get them out in three days. So far, no pain or discomfort. My night vision is pretty bad now also. I see crosses where there are lights. Two of them. Squinting helps a little and it seems that I can not even read anything that isn’t 6 inches from my face. I changed the font settings on my phone to max and that helps a bit. Also sitting really close to the monitor helps with that also. Surprisingly, I can see pretty good with my surgical loops. I can only hope that I see some improvement soon. I hate the waiting game but then again I have enjoyed listening to music again.

Day Three

I had to go into work and take care of some computer emergencies today. I can’t believe how blind I feel and how mch I have taken for granted even my bad vision proper to this post operative condition. I know it will heal. At least that is what I tell my patients who are anxious to heal faster. This experience, if it doesn’t blind me, will teach me patience with my patients at the very least.

Day Four

Vision seems to have gotten better overnight. I would say about ten percent better. I can read a monitor at 12 inches and I can read my phone (in large font) at a normal distance. I did sleep a lot today though. Having my eyes closed when not using them helps a lot. Also keeping them hydrated between drugs is helpful.  I went to a Cheap Trick\Peter Frampton Concert in the evening.  I kept my eyes closed for most of the concert which made it pretty different.  I enjoyed it.  On the way home (I didn’t drive) it seems that the night vision was also better than the previous days but Im far from driving at night.  Tomorrow I go in for my first post op appointment and hopefully the contacts are coming off.  Ive been told the day after the contacts come off, there is some improvement.

Day Five

Today I had my first Post op appointment.   A Med Assistant who didn’t mention her name, removed my contacts and looked into each eye..   My eyes tested 20\60 together and 20\70 individually.   She mentioned that there was some inflammation in the left eye and had  Dr Bindi look at them..  He told me that there was still a small area at the very apex of the cornea that was still healing and that the epithelial tissues had not yet covered that point which my vision goes through.   My eyes were a bit scratchy  but no pain after the lenses came off.  The quality of my vision seems to have improved slightly with the contacts out but still pretty bad.   I was told that tomorrow, I should see some improvement for sure.   The Dr told me also that keeping the eye well hydrated and my body not dehydrated is important in healing the clear epithelial cells over the cornea.  I remain on the anti-inflammatory and antibiotic eye drops.  My next appointment is 3 days from now.

 Day six

This morning I awoke to a definite improvement in vision. I am about 60 percent of where I was without glasses before surgery.  My old prescription does not work at all. Readers don’t seem to help either. .  My vision has definitely changed in that I can read close but not far which was the opposite of the way it was before surgery.  I have another appointment tomorrow after work with the eye doctor to check on the healing progress without contacts.  Unlike healing in the mouth, vision gives you much more precise telemetry on the healing of that thin cell layer over the cornea.  It is the fastest growing cells in the body very similar to mouth tissue and you can really differentiate the healing process through visual acuity in vey small increments. It amazes me.   I remain optimistic and can do things with loops again.  I noticed that vision drives my business.  Seeing something undone, is what motivates me to finish it.  With m y vision so blurry the last few days, I find myself looking around to try to find something to do when its right in front of my face–like a pile of bills, or dirty dishes.   I watched the blurry Warriors beat the Cavs in game 4 on the big screen tonight.  My eyes were tired after the game.  Without the contacts,  I want to hydrate my eyes even more. .

One Week

I went in for my second post op appointment with pretty much the same vision as the first appointment.   20\70 in both eyes.  The tech helped me figure out the best readers to get and warned me that my vision was changing so rapidly that   they might not work for long.  Dr Bindi even mentioned that I might get a few powers and pop a lens out and switch them if necessary. as the vision changes in each eye. I am starting to have irrational fears of not being able to practice dentistry in this condition since my eyesight has not gotten better in a week.   Dr Bihni  told me that it takes time and a fellow Lasik surgeon who he had performed PRK on took two weeks before going back to his practice.   I left optimistic that it could all get a lot better in a week. I asked him if I could expect linear progress in my vision and he said it is not linear.  He explained to me that there are actually10 layers of epithelium that cover the cornea in a healthy eye.  the first layer floats over the surface and attaches to adjacent cells till a single layer covers the cornea,   Subsequently,  the cells mitose upward.   Layers of cells stack on each other giving an un even surface that causes refractive errors.  When about ten layers form,  the surface begins to flatten out.  Because the surface of the epithelial layer varies so much during healing,  sometimes peoples eyes get better and then worse before the healing process stabilizes. . Dr Bindi mentioned he actually studied this phenomena in Med School and wrote a paper.  He told me every thing looks within normal limits and to just be patient.    I bought  several pairs of readers–a 2.75 and a 2.50 to mix and match but as of this writing, neither on seems to work very well at all.   At least it seemed to improve my site in the office while I was being tested.  I hope my eyes get better in the three days or I might have to cancel another week of patients. feeling very restless and not getting things done but I’ve read this is the “freak out” phase of PRK and its typical even with fast healing cases..  I hung an eyechart next to my bed so I can better determine my progress when I wake up in the morning.  Its got to get better.   I found an interesting article on contact lens implants today–Visian ICL.

Day 12

The last three days have been about the same.  Still pretty bad.  I could not  read anything without straining even with 2.75 readers.  Dr B has been calling and emailing me to keep my optimism up– he is a very caring doctor and follows up on his patients.   Today I woke up and looked at the eye chart on the wall and I noticed a significant improvement.   Last night I tried putting a clear contact on my left eye that seems a bit worse at the suggestion of Dr B.  It didn’t make any difference with it on  so I took it out before I went to bed.   This morning,  my site seemed to improve in that eye.   Maybe just the act of putting the lens on and taking it out somehow effected the epithelials on the cornea. I’m not questioning improvement.  Hopefully in the next two days I will see equal improvement.  My long sight is still blurry but wearing 2.0 readers is almost comfortable again reading.    I used my surgical magnifiers today and there is no problem with resolution at all at the right focal length. so I work again.   I am relieved that things are looking clearer.

Two Weeks

The last couple days, my eyesite in the morning has been about 70% which has been a huge relief.  The change from day 11 to day 12 was big but the eyes have been about the same over the last few days.with very slight improvement . I noticed that my eyesite tends to get worse as the day progresses.   Probably eyestrain. I dont feel my eyesite is as crisp as it was with glasses yet and I have read it takes up to 3 months for that to happen. Ive got nothing but time and I can funtion with surgical loops and readers 100%.    I can’t drive at night though.  I watched Jurassic World in 3D blur vision last night.   I probably shouldnt have done that but It wasnt too blurry and the 3D stuff was still pretty entertaining .    There is hopefully more  healing that needs to take place.   Yesterday  after the movie,  I worked on migrating our office server from Server 2003 to 2008..  I made a sight error renaming a server.   I couldnt figure out why the migration was failing till I noticed two  of the same named computers on the workgroup which I thought was impossible.   Turns out I just mispelled one.  It is interesting to find out how I read predictively when I cant see small type.  I miss reading.  Its hard to read all day without getting tired eyes.My next post op appointment is in three weeks.  Im going to ask the Dr.if its worth getting some RX glasses to tune up my far and near site even if it means it wont work for more than a month. Those cheap online glasses place like EyeBuyDirect.com  make it worth it–a single RX pair of glasses for $30..

Three Weeks

Today I had my Three Week Post op appointment with Dr Bihndi.  The technician measured my prescription and I am about -1.5 in each eye  for long distance vision and  at 2 for my close vision.   I have to admit that at times,  it seems my vision is very good. but as the day progresses,  my vision gets worse. I talked to the doctor about this and I told him I was concerned that I was straining my eyes working with loops in the office.   He told me that this was not likely since at my age three was very little flexibility in my eye lens.  He told me the vision is likely getting worse because my eyes are drying out during the day.     As it turns out, I might be using the wrong eyedrops.  He told me to try gel tears that are more viscous than the one I am using.   He educated me in  the difference between lubricating drops and aftificial tears.   Since using the thicker gel tears,  my vision has been staying sharper longer into the day.   I still have a hard time keeping them 100 percent hydrated even applying the drops every hour.    I decided to fill a prescription for glasses to help me see better in the next couple weeks even though I know as my eyes heal,  the RX will be useless.   Its easy to get cheap single lens glasses these days on the internet so I ordered on for close vision and one for long vision.  Most of the internet blogs I have read on the healing time after LASIK describe results 5 weeks out and up to 3 months.  Im planning for the worst but where my vision is now is workable.  In the mornings,  I think my vision is 100 percent at times.   My hope is that my eyes will stay sharp all day long eventually. and even get a bit clearer and less blurry.

 Five Weeks

The last two weeks have seen very little improvement.  but some improvement none the less.  I filled the RX for glasses a couple weeks ago and they are slowly getting more blurry but I can still see better long distance with them than without them.   My close vision is still about a 2.00 reader.  I keep reading that most people reach there best vision in 3 months.  Im hoping that I might get about 10 percent more.   It would be great if my long distance site without glasses would be as good as pre surgery.  Sometimes I hydrate my eyes and I can see almost perfectly.  I think the last ten percent is the slowest.

2 thoughts on “LASIK Surgery Part II – The Epi-Lasik PRK Experience.

    • It took 6 months before my vision stop changing. Im very happy with the result but it was a brutal recovery that might have changed my mind about doing it. I was in denial that I would take that long to heal.

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